ABSTRACT
Background:Non-alcoholic fatty pancreas disease (NAFPD) is an emerging clinical entity. NAFPD is characterised by excessive fat deposition in the pancreas in the absence of alcohol consumption. Recent studies suggest that NAFPD might be associated with beta cell dysfunction, insulin resistance and inflammation which might lead to development of diabetes. NAFPD might be used as an initial indicator of glucometabolic disturbances and identify the patients with prediabetes. Methods:This was a cross sectional study in which the glycemic status of 50 patients with NAFPD with ultrasonographic evidence of increased echogenicity of pancreas was assessed and association between glycemic variability and NAFPD was determined. The patients were also assessed for the ultrasonographic evidence of fatty liver.Results:Pre-diabetes was noted in 32% subjects while diabetes was noted in 20% subjects. Thus, 52% patients with NAFPD had abnormal glycemic status. The 48% subjects i.e., 24 patients had normoglycemia. The presence of fattyliver was statistically significant in normoglycemia and diabetes mellitus with p=0.001 and 0.045 respectively. No statistically significant association was noted between fatty liver and prediabetes with p=0.175. No causal relationship was seen between fatty liver and glycemic variability in patients with NAFPD.Conclusions:NAFPD is associated with impaired glycemic status. It is also seen frequently with fatty liver. Its early detection may help to identify the patients with prediabetes who may benefit from timely introduction of interventions to reduce the rising morbidity and mortality due to diabetes mellitus.
ABSTRACT
Background: Cardiac arrhythmias are quite common in the setting of acute myocardial infarction. Ninety percent of patients with acute myocardial infarction (AMI) have some cardiac rhythm abnormality, and 25% have cardiac conduction disturbance within 24 hours of infarct onset. These are tachyarrhythmias, ventricular arrhythmias, and atrioventricular block. A good correlation exists between the site of infarct and type of arrhythmias. Sinus bradycardia, sinoatrial escape rhythms, Wenkebach type and complete heart block are usually associated with inferior wall myocardial infarction (IWMI). Atrial premature contraction (APC) and ventricular premature contraction (VPC) are usually seen in anterior wall myocardial infarction (AWMI). Methods: The present cross-sectional study was conducted on 100 consecutive cases of acute myocardial infarction with arrhythmias attending as indoor emergency patients of Guru Nanak Dev Hospital attached to Government Medical College, Amritsar were included. History, clinical examination and required investigations including lipid profile, blood sugars, electrolytes, CPK-MB, ECG, and 2D-Echo were done. Results: Out of the hundred patients in the study, males (57%) outnumbered females (43%). Most of the patients were found in the age group of 51-60 years (34%). Smoking was the most significant risk factor (38%), followed by diabetes mellitus (35%), hypertension (30%) and prior ischemic heart disease (28%). The majority (56%) of the patients had anterior wall myocardial infarction (AWMI), followed by IWMI (24%), IWMI + RVMI (13%) and AWMI + IWMI (7%). Most of the arrhythmias (62%) developed during initial 24 hours of admission, while 27% in next 24 hours and 11% after 48 hours of admission to hospital. The most common arrhythmia observed was VPC (50%), followed by sinus tachycardia (48%), sinus bradycardia (16%), accelerated idioventricular rhythm (9%), 3rd degree heart block (7%), ventricular tachycardia (6%), 1st degree Heart Block (5%), 2nd degree Heart block (5%), ventricular fibrillation (4%), APC (4%) and AF (1%). Maximum incidence of VPC, sinus tachycardia, ventricular tachycardia (VT) and ventricular fibrillation (VF) were recorded in AWMI, while the maximum incidence of sinus bradycardia and AV block were observed in IWMI. Mortality was more common in patients developing arrhythmias specifically VT, VF and heart blocks especially 2nd-degree heart block and 3rd-degree heart block. Conclusion: Most of the patients with acute myocardial infarction develop some kind of arrhythmias which is an important cause of morbidity in these patients, develop during the initial 24 hours of admission to the hospital. Most common arrhythmias observed were VPC, followed by sinus tachycardia, AV block, bundle branch block, sinus bradycardia, VT, and VF. VPC, sinus tachycardia, VT, and VF were more common in AWMI, while sinus bradycardia and AV block were more common in IWMI. Diligent monitoring for arrhythmias and appropriate treatment can be life saving.
ABSTRACT
Background: In cirrhotic patients, in addition to hepatocyte and Kuppfer cells dysfunction, portopulmonary shunt, intrapulmonary arteriovenous shunt and VA/Q inequality can induce a decrease in PaO2 and SaO2 as well as acid base disturbances. The present study was done to analyse arterial blood gas changes, prevalence of hypoxemia and acid base disturbances as well as to correlate grading of hypoxemia with different aetiologies and Child-Pugh score in patients with liver cirrhosis and ascites. Methods: The present correlative cross sectional study was conducted on 100 patients with cirrhosis and ascites for a period of 24 months. Arterial blood gas samples obtained by percutaneous radial puncture were analysed for various acid base abnormalities and arterial blood gas oxygenation. Results: Acid base disturbances observed were: respiratory alkalosis in 39 cases (39%), metabolic alkalosis in 20 cases (20%), metabolic acidosis in 11 cases (11%), metabolic acidosis with respiratory alkalosis in 10 cases (10%) and no acid base disturbance in 20 cases (20%). Mean values of PaO2 was 75.85±7.8 mmHg, PaCO2 was 35.27±5.13 mmHg, pH was 7.44±.115 and HCO3- was 23.65±3.85 mmol/l. Alcoholic cirrhotics had hypoxemia in 42% cases in contrast to hypoxemia in other aetiologies ( Hepatitis C 18%, Hepatitis B 5%).Conclusion: Metabolic abnormalities, hypoxemia and hypocapnia are commonly found in cirrhotics. Hypoxemia is more common in alcoholic cirrhotics but has no correlation with Child-Pugh score.